A life in veterinary medicine is, necessarily, a life of paradox, and it begins no later than veterinary school, where we build the foundation of a career dedicated to the preservation of life, and the prevention of suffering. This is particularly true for those pursuing a career in small animal medicine.
On Day 1, we walk into our anatomy lab, and we are introduced to our specimens, which we will spend the next few months dissecting. Unlike in human anatomy labs, these dogs did not willingly donate their bodies to science. The sourcing is a bit murky, but in our college lab the dogs had come from a commercial enterprise, which had obtained them from shelters, where they had been euthanized. Our school also had live animal laboratories, in which surgical techniques were taught on living dogs, which were then euthanized. Then, there is a profusion of research, that we study, all based upon experiments performed upon perfectly healthy dogs, to learn medical techniques, for the benefit of a much more fortunate population of dogs.
Fortunately, technological advances, and a more enlightened view of animal rights has resulted in some schools eliminating some of these practices, but it is still a pervasive aspect of veterinary education and research. The ethical and moral arguments regarding these practices are outside of the scope of this column. I mention this only to illustrate the inconsistency that follows us throughout our careers.
Every veterinary hospital faces the heartbreaking cases, in which a pet, with a treatable disease, is euthanized for lack of funds. The level of care we are expected to provide as veterinarians is at an all-time high. So our clients expect access to the state-of-the-art equipment, and services provided by the most highly trained professionals that the job requires. For some, the cost is but an after-thought, but for others it is a barrier to the care their pet needs.
So, while we go to the ends of the earth to save the life of one patient, another, who is equally curable, but financially challenged, may be left untreated or even put to sleep. I do my best, in my practice not to allow this to happen. As a surgeon, I have never euthanized a treatable patient over money. But it sometimes means we have to get creative to hit the nexus of effective therapy, and affordability.
Grace is a German Shepherd with a condition known as Primary Absolute Polycythemia Rubra Vera. With this disease, the bone marrow manufactures too many red blood cells, resulting in the blood becoming too thick. This can lead to major circulatory issues, such as blood clots. This leads to a loss of energy, organ swelling and death if untreated. One of the treatments is reminiscent of the Middle Ages, and evokes images of leeches, and bloodletting, and that’s for good reason. One of the mainstays of treatment is actually draining blood from the patient.
I saw our medicine technician, Heather, walking down the hall with two bags of blood, and I asked her where they were from. She told me about Grace and we talked, half-jokingly, about what a shame it was to throw away so much blood, when banked blood was so expensive. It seemed like such a waste. This sparked a group discussion among doctors and technicians about using this blood if there were no other alternative. The general consensus was that under the right, or wrong, circumstances this blood could be used, but only as an absolute last resort.
At about 6 p.m., the same day, a stray puppy was dropped off at the emergency clinic. It was loaded with intestinal parasites, which were draining his blood. He was pale as a ghost, and his bloated belly indicated why. His blood was being drained by hookworms, and he was so anemic, that his blood was nearly clear. He had one-eighth the number of red blood cells in a normal dog. Our emergency clinician called me, and had concluded that euthanasia was probably the right course, given how sick this little guy was, and a lack of a financially responsible party.
I thought about Grace, and wondered if that blood had been thrown away. I told the clinician about that blood, and said I thought that it was perfect for this case. There was a stunned silence on the line. The fact that I was suggesting that we use the excess blood, from a diseased dog as a treatment, sounded insane. But, I reasoned that the side effects could not be worse than euthanasia. I asked Heather if she had thrown out the blood, and her reply was, “You know me better than that B, it’s in the fridge”. Within the hour it was in the puppy, and within a day, it was like a new dog.
Sometimes nothing but the state-of-the-art will do. But the true art of medicine is adapting what’s available to what is needed, and what the conditions will allow. Sometimes saving a patient requires taking a chance, and finding the sweet spot between ‘nothing but the best’ and ‘any old port in a storm’.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to email@example.com.