If the action isn’t different…

Our family has two pets – a cat and a dog.  Both are getting older, and like humans, there is a rising cost to health care for pets as they age.  Particularly, end of life care, or attempting to prolong life is particularly expensive.  Atul Gawande tells some of that story in his article “Letting Go.”  In addition, I happened to be listening to NPR the other day, where a guest pointed out that 66% of the medicaid costs were incurred by just 25% of the people – mostly elderly in end-of-life care situations.  For pets, we often have to make hard decisions about what care is worth giving and what is not.

Please don’t take this is cold-hearted about my pets, because we do love them and have enjoyed them in our lives for 11 years, but I’m a data person and listen hard to the facts.  I accept, as much as we want to think otherwise, that we’re unlikely to escape the statistical realities.  But, I digress…

Our cat, Lily, had stopped eating.  We took her to the vet for an exam, X-rays, blood work, fluid injections and more to try and get a clue as to what was going on.  After the tests came back, the vet called me and gave us two possible diagnoses.  One was some sort of gastrointestinal issue, the other was cancer.  Her opinion (I’m not sure it was actually backed up by true statistics) was that it was as 50/50 chance to be one or the other.  She proposed that we bring Lily back in for an ultrasound, which was more sensitive to soft tissues than an X-ray.

I asked the vet, “once we know the outcome, what are the treatments?”  In reply, she told me that if it was cancer, she would give Lily steroids to improve her energy level and appetite (plus apparently steroids make cats thirsty so she’d also drink more and avoid dehydration).  But, ultimately, that would only help for a short while and she would degrade again and there’d be little we could do beyond that.  If, however, it was an intestinal issue, the steroids would improve her eating and energy level (as well as her drinking) and she’d be on them the rest of her life, however long that might be.

What value did the ultrasound provide, I wondered.  If it’s cancer, the treatment is steriods.  If it’s not cancer, the treatment is still steroids.  The only difference is that either it would work for a short time or a long time.  So I declined the proposed ultrasound and told her to prescribe the steroids.

The reality is, although it might be interesting to have a diagnosis, in either outcome we would have the same path of treatment.  The avoided costs of the ultrasound, which would run several hundred dollars, could then be spent directly on steriods and specialized food.  Being the optimist, I picked up the steroids and popped off to the pet store for a whole case of special cat food.  My wife thought I was crazy coming home with a whole case.

Of course, just 2 days ago we used up the last of that case, and I bought another case of the food at the store.  I’m glad that the issue appears to be intestinal and not cancer.  But the story applies for all kinds of decisions.  If you take a step to analyze, collect data, etc., but regardless of the outcome it leads to the same next action, skip the analysis.  It’s just a waste of time.

Time, in my case, that could be better spent not traumatizing our cat and instead cuddling with her for however many more months or years of time we get.

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