Extraordinary Measures, or Not

I love my dog, Cosmo, and because I love him, I don't want him to suffer. As he's gotten older, he's developed various ailments, though surprisingly few for his advanced age of twelve—a seizure disorder, bad knees, ears prone to infection. Lately, he's added another complaint to his roster, pancreatitis. So far, he's only had a few mild episodes, months apart and lasting less than 24 hours. But today, I was confronted with a classic medical dilemma—whether the treatment recommended would be worse than the disease itself.

Here's what happened—I had an appointment with Cosmo's new vet (see my earlier post, "Vetting the Vet") to check Cosmo's blood. Cosmo had required an increase in seizure medication eight weeks earlier and the tests were intended to make sure his liver was still functioning well at the higher dose. As luck would have it, the day before the appointment, Cosmo showed signs of digestive distress. He woke us up in the morning by throwing up, then acted listless and weak. He didn't seem to be in pain, just tired and lacking in energy. I didn't offer him food since I wanted his stomach to settle down, and in any case he seemed uninteresting in eating, but he drank some water and seemed to be resting comfortably.

He had a quiet day and by evening seemed much better. The next morning, when I saw the vet, I described the symptoms. I was feeling slightly guilty, since earlier tests had revealed that Cosmo's blood had a high fat content, which can bring on attacks of pancreatitis. I had attempted to switch him to a low-fat dog food, but when Cosmo didn't like it, I relented and gave him his regular food. After all, I reasoned, food is one of the great pleasures of Cosmo's life. I didn't want to deprive him of enjoying his meals.

I confessed this to the vet, who didn't seem overly concerned, or maybe he wasn't really listening. He took Cosmo's blood and promised to let me know the results as soon as he received them. When he called first thing this morning, he sounded alarmed. Cosmo's amylase and lipase levels were high, he said, suggestive of pancreatitis. Cosmo really needed to be hospitalized, where he could be placed on IV fluids and nutrients. Further, the vet felt Cosmo needed an ultrasound to confirm the diagnosis and told me Cosmo should not be fed for four days, in order to give his pancreas a rest. This was a lot for me to take in, especially before I'd had my morning coffee.

It was also a lot to contemplate in terms of cost. I had just spent an astronomical amount the prior day on the office visit and blood tests. Now, I would be out thousands of dollars for hospitalization and ultrasound testing. More importantly, though, I thought the experience would probably kill Cosmo. He's old, he's fragile, he doesn't like us to leave him. To hospitalize him, unless it were absolutely necessary, seemed like cruel and unusual punishment.

I expressed my reservations to the vet. He urged me at the very least to refrain from feeding Cosmo for two days and to bring him in for a subcutaneous injection of fluids. I said I'd think about that. Then, like the obsessive researcher that I am, I began checking the Internet.

What I found is not that the vet made incorrect suggestions, but rather that his treatment plan comprised a one-size-fits-all draconian remedy, more appropriate for a dog with an acute case of pancreatitis than Cosmo, with his much milder version. IV fluids would be indicated if a dog were seriously dehydrated, which Cosmo was not. Refraining from feeding might be necessary if symptoms continued, but Cosmo's symptoms had abated after twelve hours. An ultrasound is a good tool for diagnosing pancreatitis, but since I'm going to proceed on the assumption that Cosmo did have a mild attack of pancreatitis, I don't really need a test to confirm that. 

I don't regret the expensive blood tests. They made it clear that I should do everything reasonably possible to lower the amount of fat in Cosmo's diet. But the measures proposed by the vet seem out of proportion to Cosmo's actual situation. And to make matters even more complicated, my Internet research revealed that while withholding food has long been the standard of practice in treating pancreatitis, newer information suggests that once the dog is interested in eating, frequent small portions of low-fat food should be offered. So the advice to starve Cosmo for several days may have been outdated.

Worst of all, I find myself suspicious of my vet's motives. He stood to make a lot of money if I allowed him to treat Cosmo as he originally advised. For now, I plan to limit Cosmo to the lowest-fat foods possible and watch him carefully. I want to do everything I can to keep him happy and healthy, and to make sure he doesn't suffer. Hopefully, extraordinary measures won't be necessary.