The cost of knowledge for your sick pet

Coming into the internship from a public health angle has been interesting. There's a lot of frustration among the veterinarians about clients who don't understand the costs associated with care, or who are trying really hard to learn about medicine but getting it wrong.

For people on a strict budget, taking an animal to the vet is a luxury. I suppose there are some ethical issues about whether you should have a pet if you can't afford to take care of it, but many of these people take terrific care of their animals, they're just not equipped to handle the sorts of health problems that require multiple tests and hospitalization. I am not going to blame anyone for not knowing how much it costs to go to the vet.

In just one month I've seen a lot of shocked faces when we tell owners that the basic work-up for their animal is going to be 500-1000 dollars.

1. Internal medicine is always expensive. Finding answers is expensive, and by expensive I mean $1,000 and up.
2. Pancreatitis is expensive and super frustrating to treat, since it can last for weeks. Hospitalization tends to be $400 a day, for all the meds and monitoring that we do. 
1. For a dog that has to be on fluids for a week or more, that quickly turns into a $3,000 bill. Even the affluent owners start to squirm at that point.
2. There are some wonderful drugs out there to reduce nausea. They cost a lot. I assume people have successfully treated pancreatitis without these wonderful drugs. However, many clients are hospitalizing their pets because they want Fluffy to feel better, not just eventually get better. And one of the fastest ways to get Fluffy better is to make her feel better, so the circular logic says it's worth the investment.
3. Feeding! I love the fact that medicine has started to come around to say that feeding dogs with pancreatitis probably actually helps. I am a huge proponent of starting enteral nutrition as soon as possible, which given my relative inexperience and lack of commitment to a specific line of treatment on almost every disease process in the world, demonstrates either huge personal bias or the power of selective attention to rapidly develop understanding of a disease process. I saw a lot of pancreatitis dogs last month.
3. Big dogs are more expensive. They need more fluids, they need more drugs, and they can be much harder to manage at home.
4. Imaging in a perfect world is radiographs AND ultrasound. We try to look at everything with ultrasound, but it's like making a map on foot vs. doing a fly-over and getting a snapshot of everything. I don't know what the average cost of ultrasound it; here it is $300, while radiographs (two views are so much more helpful than one) are $125.
5. Kitty replacement value. Animal Control routes a fair number of strays through the clinic. These are cats who get maybe an x-ray or some bloodwork and that's their $100 cap. There are some perfectly healthy strays we never see. Yet each one is a potential crash'n'burn. And in the meantime, we have cats who are total wrecks, who have already done a crash'n'burn, and their owners are investing multiple grand to keep them going. It is a weird mindframe, to go back and forth between minimal and absolute max investment. It is all based on human-animal bond, so one of my other burgeoning opinions is that owners visiting is to be encouraged. Because especially with cats, the replacement value of a cat is completely determined by the bond with the owner.