One of my high school classmates became a veterinarian as a second career. When she (and I) went to college the first time, women were not exactly being encouraged to apply to veterinary school (the dark ages — sometime between the Norman Conquest in 1066 and 1980). She became a teacher, despite really always wanting to be a veterinarian. She went back to school, got some science courses as pre-requisites, and graduated from veterinary school at the tender age of 48. Six years later, she confided to me that "… sometimes I don’t feel like a real veterinarian. My boss does most of the surgery, serious cases get packed off to the emergency clinic after five…" On the other hand, she has had the experience of being on night call every other night and seeing her own emergencies… and she didn’t like it.
So what is a "real veterinarian"? I think that whether we admit it or not, a lot of us have that James Herriott gentle doctor as our role model. This is not a bad thing, but it requires you to be all things to all people, which is a mighty tall order. Too tall for 24/7, 365 days a year, not to mention that you can hardly be an expert on everything. I’ve been on the front lines for a long time, seeing "all comers" as their primary care veterinarian. I am very glad to have the opportunity to consult with specialists and to have specialists to refer my patients to when it is possible for the clients. In years past, because of my rural location, I’ve been forced to learn procedures that I’d have never touched if we were thirty minutes away from the university teaching hospital. That’s made me stretch and learn and given me the confidence to try new things. I can’t say that it’s always been the best for that "first patient" (though, truthfully, their alternative in those situations was to have NO treatment).
Of course there’s more to the Herriott model than simply seeing whatever species and problem walks in. It’s also about being part of the community, being "the vet", being available when your clients need you, even when it means some sacrifices in your personal life. This can bring great satisfaction, but it also can bring great fatigue, which brings me to how I got started on this: being the day guy and the night guy.
Last night (this morning?) at midnight-thirty, I got a call from the police station. "These two ladies have brought in a dog they just hit, and I didn’t know who else to call." [Me neither, or I’d sure give you his number.] This little gal had no I.D. and no visible means of support. While she was generally pretty stable, she was not too conscious. That, along with constricted pupils and a little nose-bleed, suggested a cerebral concussion (brain-bruise).
She was better this morning, and continues to improve, though I reckon she’s still got a headache, pain medicine or no. We’re optimistic about her full recovery and finding a home for her. That’s a good thing. Feeling like I was out all night — not such a good thing. Does it make me more of a "real veterinarian" than my classmate who doesn’t like surgery and night emergencies? I don’t think so. You find a niche where your talents satisfy a need, and do your best. That’s real enough, I think.
Here is where I am, and this is what I do. It’s not for everybody, but if you know a nice young doctor who would enjoy small town life, I’d love some help.
Hi Vet Doctor,
I came upon your blog after googling “dog with cancer, treatment.” My Great Pyrenees was rescued by sheriff and Humane Society from a Douglas County puppy mill; she had spent her life as a caged breeder; she is an older dog. Her name is Angel and I’ve had her for only three years. The vet says she has breast cancer and her tumors are palpable. We took her to the vet oncologist and he quoted a BOATLOAD of money for treatment. Do you know anyone at all who will be able to treat my Darling Angel on some kind of income-based sliding scale? I don’t want to put her through misery just because she’s had such a hard life already, but I sure don’t want to lose her. Please can you kindly advise me?
Sincerely,
Patrice
Des Peres, MO
Dear Patrice,
Well done on the rescue operation. Chemotherapy in dogs is somewhat different than in people, as we generally use lower doses of drug. This results in much less difficulty for the patient than we typically think of. With people receiving chemo, they usually feel terrible, and this is often NOT the case with dogs. Here is a link to a previous post on the subject: http://www.yourpetsbestfriend.com/your_pets_best_friend/2006/09/chemotherapy_is.html
With mammary tumors, surgical removal is usually the first step, and this can be complicated. With modern anesthesia (read MUCH safer when I say modern) and good support during surgery, such as being maintained on I.V. fluids, you simply cannot do this cheaply. Even if the doctor were willing to work for nothing (which doesn’t seem fair), the expenses and support staff must be paid.
Chemotherapy has several different possible expensive components. Some (though by no means all) of the drugs are very expensive, and the bigger the dog, the more you spend. It is not uncommon for the wholesale cost of the drug (i.e. NO markup to you, the client) to be fifty to one hundred dollars per dose.
Some of these drugs must be administered in a free-running I.V. drip at a measured rate over a period of no less than thirty minutes. This requires an I.V. pump (not a cheap device) placing an I.V. catheter, the fluids, tubing, tape, and a staff person supervising for that thirty minutes.
Chemotherapy drugs are hazardous materials and require special handling and disposal.
Prior to each chemotherapy session, blood must be drawn for a complete blood count to be sure that the previous treatment has not damaged the bone marrow. If that had occurred, another treatment might permanently destroy the patient’s ability to produce blood cells.
Some years ago, under VERY special circumstances, I treated a 60-pound dog for lymphosarcoma, charging only my own out-of-pocket costs. [This is NOT something I can afford to do regularly.] The patient achieved only a two-month remission, and the cost to the client was about $900. It was a very discouraging situation all around. They don’t all turn out like Checkers: http://www.yourpetsbestfriend.com/your_pets_best_friend/2006/10/in_memoriam_che.html
The only way that I know to mitigate the cost of these complex and expensive treatments would be to contact the University Veterinary Teaching Hospital to see if there are any research trials going on. Sometimes a research project is looking for a particular type of cancer to try out a new treatment and grant money helps to pay for it. These trials tend to be few and far between, however.
Thanks for reading.