Monday, June 25, 2018

Vets, Money, and Our Pets-How Far Can We Be Prepared for Pet Healthcare?

Regarding the post about the vet who saved a dog that was experiencing a difficult delivery-after another corporate vet service denied surgery because the owners could not afford it. That story-while not HCM specific-does address issues we all have or will face: the ability to provide healthcare to our pets; the denial of care based on affordability; the stress and strain of owning a sick pet; and the difficulties of dealing with vets who want money more than they want to help a pet.

Providing care for an HCM cat is expensive. We would spend $150 a month on medications and supplements for Myrna (some supplements were used by the other cats); save $300 a month for future ER visits-which she would have once or twice a year; and spend $350 per cardio visit which she would have four times a year. And we had at the time, six other cats that needed annual visits and periodic visits for other issues. We did not take vacations; we did not buy a lot for ourselves. Our budget was tight.

In the comments in the other story, those who are vets said: "Irresponsible owners! Should have saved for possible healthcare of pregnant dog! Should have spayed! Should have been better prepared! We can't treat without money!"

Who gets a cat and thinks about healthcare? Hardly anyone. But per the vets' comments, when we get a pet, we need to think about and plan for their healthcare expenses. We know they need annual shots. But no one expects a cat will get a disease and will need $600 a month in vet care (spent as well as saved) any more than we expect them to get injured (in the home), or get seizures, or suddenly develop high ALT values. We knew the cats needed rabies shots; we had experience with bladder and UTI issues from the two other cats so knew those things could occur. And we had gone through an expensive attempt to treat what we thought was pancreatitis that turned out to be pancreatic cancer and had to put down an older cat. So, we were experienced with various healthcare issues. We understood healthcare was a necessity. This wasn't new for us. But we never expected HCM. As much as we thought we were mentally and monetarily prepared, we were not. But still, is that our "fault" for not being prepared for HCM? Or just circumstances?

So, yes, an owner needs to think about and plan for healthcare and save for the future needs. Insurance is one option but none cover AFTER the cat gets HCM and most have limited coverage for diseases; and when you have more than one cat, paying for health insurance can be cost prohibitive. (But do look into getting insurance.) From the pancreatitis/cancer issue, we already had signed up for Care Credit which was a blessing for emergencies even if expensive to repay. (Six months no interest means that you repay every $1000 you borrow at $200 or so a month. Myrna's ER visits would be on average $1200.) So, we had access to money for emergency needs. But we never expected a cat to get a chronic, expensive disease such as HCM. When we think about disease, and when vets discuss disease, it's usually end of life issues for the senior cat, kidney disease, heart worm, etc. But no one tells you your cat could get heart disease and that it would be emotionally taxiing and expensive.

One reason why we are not told to be prepared for serious health issues may be because too many vets believe that chronically ill, seriously ill cats should be put down. They dismiss the necessity of care. We have-or we will-all experience this. Too many vets have told you the readers, that it's a waste of time to treat HCM because it is a life threatening and life ending disease and to put the cat down. Can't we say that about any issue? Even our own? Aren't we all going to die one day? Why do we treat anything then? But you-and I-forged ahead, saving the cat even if for "only" six more years. We were told it would be a waste of time and money to save Myrna's sibling Clarkie when he was two weeks old and appeared to be dying, "failing". "Normal"-said the vet. "Happens. Put it down. Hard to save. Would need constant care and around the clock feeding and meds." We insisted. He recovered and is now a healthy nine year old cat whose owner still posts photos to Facebook so that we can keep in touch. Too many vets seem to value money over the care of a pet and do not value the life of the pet over the money. We have in the US a law that says all emergency human patients must be stabilized and treated before asking for payment and cannot be denied if they cannot pay. We need such a law for pets.

So, the vet who refused to do surgery on that poor struggling dog in labor did so because they are owned by a corporation. The corporation refused service because the owners did not have enough money. They allowed a dog to suffer and a puppy to die. But even individual practices may choose to refuse care. In this case, putting down a pet is the only thing recommended, which is what the corporate vet practice told the owners. But who wants to put down a dog because of LABOR problems? Who thinks of that as a life ending issue? Cancer, yes. Severe blood loss due to injury, understandable. But labor?

Should the owners have been better prepared? Sure, for the delivery for sure. Had they talked to anyone about possible issues? Maybe they had and that's how they knew to bring the dog to the ER in the first place. Did they think to save for the delivery issues? Maybe they did and that's why they had some money (let's say they had $1000 and the surgery was $2000.) When the kittens were about to be born in our house, I read up on it. I asked our vet tech how to prepare for the birth. I learned from her about labor distress which is how I knew to bring in the mother when she couldn't expel a kitten after an hour (she had given birth to four by then. The next three would be in the ER.)

But what if while pregnant the dog had run into something and become impaled; or broken a leg; or developed kidney disease? Just how prepared are we to be? Just how far down the road, and the expense, are we to think? And who can think that far? At some point, we do all that we can do and the rest you can't do because you haven't experienced it and no one has told you to be THAT prepared. Until it happens, you don't know what to expect. Which is why when I thought Baby had heart disease, I redid the budget for the next two months and gave her a a couple hundred dollars more for vet care because we had gone through this with Myrna. And so I knew what to expect (but thankfully, Baby is fine.)

So, I'm prepared for pancreatic cancer, end of life issues, HCM, UTI, and now seizures. And there are a few hundred more possibilities that are unknown. How can I be more prepared? I can read up on them, research them, etc.
But when you Google cat health issues, there are a variety of things and all with the same, bland, general descriptions and "Here are some symptoms"-which tend to be the same for all diseases (lack of appetite, lethargy, etc.) So, being prepared is difficult to do until something specifically happens. Then you can Google for specifics.

So, yes, get health insurance if you can; set aside funds to save for healthcare for your pet. And take the cat to the vet on a regular basis. Do not dismiss symptoms such as weakness, lethargy, not eating, or low energy, or odd movements, or runny nose or goopy eyes, or cold feet, or dragging of the legs, or breathing heavily. A cat specifically, sleeping all day, or hiding, or not eating is not normal. Those are often signs of illness. Don't let a cat go more than one meal without eating; and do not let a cat suffer with a fever. And those are only SOME of the things for which one needs to watch when it comes to our cats, especially our HCM cats.

And stand up to vets and demand better care. Find a vet with whom you can talk and feel that you are also heard. You need a partner, not an adversary, when it comes to pet care, especially with HCM. And if you can, donate to vets or programs who help cats in need.

At some point, you will find yourself struggling during a new situation with your HCM cat, or any cat; struggling with payment; struggling with a vet. It will be like starting over. But we do it because we must. We do it out of love. We do it because we value the pet over money and time and ourselves.

Thursday, June 21, 2018

Baby Heart Health Scare Becomes Just Asthma

We had a health scare this past week. Last weekend-June 8-I noticed Baby breathing hard. I kept noticing it, then noticed that it wasn't just when she was grooming or active or upset. It happened at rest. The breathing rate was 40s-50s. So, I took her to the vet on Tuesday. Xrays showed a possible enlarged heart-one rib larger than last time. Now, the actual mathematical equation used to calculate size of heart to ribcage is more involved than just counting ribs. But to my experienced but untrained eye, it looked larger from both views. The lungs were clear. They emailed the results and xrays to her cardiologist. The dear woman was away at a conference but her office was concerned and called her to take a look. She texted me for feedback and after discussion-she saw no congestion-but since there were no appointments until the following week to see the cardio, she put Baby on lasix 5mg BID (twice a day.) Baby responded well Thursday and Friday morning but the breathing rate was up again so I put her on 5mg TID (three times a day.) She responded well to that. Her breathing rate fell to about 24-32, and she was perkier, and playful.
At some point, I said "No, not again. And poor Baby. But she is 13 so this could happen at any time as she ages."

Finally, we saw the cardio yesterday. And...nothing.
No enlarged heart-it's just slightly larger because it can happen as a cat ages but that is not due to internal workings and does not affect her health. Plus, she wasn't centered well on the xrays. But the echo was clean, no heart size changes, no SAM, no murmurs, no other obstructions or physical changes, no congestion, no fluid in or around the heart or lungs, and no signs of fluid in the body.

So what gives? We had a good laugh because she said my kitties are always coming up with some odd medical thing she's never seen. It's possible it's allergies or asthma kicking up when it was hot and humid. It's possible she needs her albuterol (for asthma) twice a day now instead of once. It's possible that she responded to the lasix because it can have a bronchial effect that is lost with long term use but was there in the short term. So, she's off lasix. She will receive albuterol BID and I may need to put her on the steroid Flovent. But we'll see.

HUGE sigh of relief and a prayer. And a good laugh. Because really-you must laugh.

Grain Free, Special Raw, Homemade Pet Food NOT Good-Increase in Heart Disease Seen

A recent increase in heart disease in dogs, specifically dilated cardiomyopathy (DCM), eating certain types of diets may shed light on the role of diet in causing heart disease. It appears that diet may be increasing dogs’ risk for heart disease because owners have fallen victim to the many myths and misconceptions about pet food.
Lately, there has been a huge upswing in dog breeds that are not usually affected by DCM becoming diagnosed with the disease. Turns out most of these affected dogs were eating boutique, grain-free, or exotic ingredient diets.
Linked below is an article from a veterinary nutritionist and a professor at Cummings School of Veterinary Medicine at Tufts University regarding the link between these grain-free diets, taurine deficiency and DCM.
http://vetnutrition.tufts.edu/2018/06/a-broken-heart-risk-of-heart-disease-in-boutique-or-grain-free-diets-and-exotic-ingredients/

Blood Results Jimmy and Katharine

Blood results:

Jimmy's ALT-liver value-decreased this past month while on Denamarin (a supplement for livers) but after also not having had Solequin (behavioral supplement) for the past month. ALT is 169 from 191. He should be no higher than about 130 so we still have a ways to go.

Katharine's phenobarbital blood level is 23 and the therapy range is 15-30 so she seems to be doing well. And she's physically doing well so far. We must give her Mirtazapine because her appetite has suffered. But a 1/4 of Mirt seems to last a few days. Hopefully, the lack of appetite corrects itself. I tried Cerenia and cypro but they did not help her to have an appetite. If you recall, Katharine developed seizures suddenly last month and they thankfully turned out not to be due to a brain tumor, cardio, kidneys, or any other disease or physical ailment.