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Thursday, January 20, 2011

Pushing The Boundaries Of What We Can Do

Back in December, The News & Observer (based out of Raleigh, North Carolina) published an article describing bone marrow transplants in dogs.  I found it interesting for many reasons.  First, I hadn't heard of this being done in dogs.  Second, it was being done at the North Carolina State University College of Veterinary Medicine, my alma mater.  Here are a few quotes.

Dr. Steven Suter of the N.C. State University College of Veterinary Medicine is scheduled to perform the surgery Feb. 2 in Raleigh. Suter started the canine bone marrow transplant program about two years ago with machines donated by the Mayo Clinic.
Since then, 36 lymphoma-afflicted dogs have gone through the procedure. The survival rate for dogs that undergo traditional chemotherapy treatments for lymphoma is less than 2 percent.

Although some dogs relapse within months of the surgery, 60 percent of dogs that have left the hospital have survived so far. The longest surviving N.C. State dog had the surgery 22 months ago. There haven't been enough transplants or enough time to pinpoint a cure rate, Suter said.
Although N.C. State was the first vet school in the nation to provide the transplants in a clinical setting, dogs have undergone bone marrow transplants for decades. If not for canine research, human bone marrow transplants would not be as commonplace as they are today.
"The dog has been the transplant model for close to 35 years," Suter said.

It's the last part that really got my mind thinking.  When dealing with my exotic patients I run into the problem that we often can't run lab tests because of the size of the patient.  For example, it's hard to safely collect a sufficient blood sample from a hamster.  We have normal lab ranges for the various common values, but it's difficult to get enough blood to run.  So we have the capability to do it, but are limited by our patients.

Really, that's true of many things in veterinary medicine.  We have capabilities that go beyond what we commonly see.  And that make sense, because any surgical or medical procedure is performed on animals before humans are ever involved.  So virtually regardless of what human doctors and surgeons do, theoretically vets can do these things because they were first done on animals.  For example, we commonly know about kidney transplants in humans.  Did you know that this can also be done in cats?  Here's an article on the surgery with some great and detailed pictures.

So why don't we do these procedures more commonly?  In my opinion it simply comes down to money.  In human medicine most of the costs of such therapy is covered by insurance.  People pay only a fraction of what it actually costs.  But in veterinary medicine very few people have pet insurance so the entire cost of the procedure must be paid out-of-pocket, and this can be substantial.  Bone marrow transplants in dogs?  It runs around $20,000.  And the vast majority of pet owners simply can't afford this kind of money.  Of the rare ones who could, few of them would spend it for a pet.  However, there are certainly those who will, and I admire them.

From the above article:
Gibson and his wife, Rebecca, are planning for Potter's medical care to cost about $20,000, including pre-surgery treatments and travel costs. Working with a website that raises money to help pay for canine cancer treatments, they have set up a fund to collect money to help with the cost.
Gibson, 30, a lawyer, figures about 10 percent of what they need will be donated. "We're just going to put the rest together," he said.
Potter, who received his diagnosis in October, seemed healthy one day and was stricken with terribly swollen lymph nodes the next. Doing nothing was never an option.
Gibson realizes that some people will not understand the couple's financial dedication to their dog. If Potter were older, they might make a different decision.
But with a successful transplant, he said, "we could have Potter for another 10 years." 

But even though this seems like a lot of money, it's still a fraction of the cost of the same procedure in humans, which can run $100,000-200,000. Veterinary medicine is still a huge bargain compared to human medicine.  And veterinarians are just as capable of performing complicated and extensive treatments and surgeries as their human colleagues are.  So really there should be no more limits on what we can do medically and surgically with animals than there are on humans.  Hopefully we will reach a point in the near future where pet insurance will be more common and viable, and we can start seeing these treatments performed more commonly.  Such care can significantly improve the health and lifespan of our furry, feathered, and scaled friends.

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