Issue Date: June 15, 2003

Friend for life

Kidney transplants for cats? Heart surgery for dogs? It's not so far-fetched. A panel of veterinary specialists brings us up to date on procedures that can restore the vitality of your beloved pets.

By Steve Dale

Pet owners demand specialty medicine. They want the best for all family members.

If a doctor can do it, odds are a veterinarian can, too. Pretty much everything available in human medicine is now a reality in veterinary medicine. If your vet doesn't have the equipment or expertise, there now are veterinary specialists in neurology, ophthalmology, dentistry, parasitology (someone's gotta study fleas), toxicology and oncology, as well as other kinds of medicine.

The advantage of seeing specialists is the same as in human medicine. That person has special training; it's all he or she does. Although a vet in general practice may have limited experience replacing hips in dogs, a veterinary surgeon with an interest in orthopedics performs that same surgery many times each week. Of course, you pay more for that expertise.

To talk about cutting-edge medicine and issues -- such as cost, and how veterinary medicine and human medicine work hand in hand (or hand in paw) -- USA WEEKEND rounded up a pack of respected veterinary specialists: veterinary oncologist Philip Bergman, president of the Veterinary Cancer Society and head of the Donaldson-Atwood Cancer Clinic and Flaherty Comparative Oncology Lab at the Animal Medical Center in New York City; Thierry Francey of the School of Veterinary Medicine at the University of California, Davis, an internal medicine specialist with a fellowship in nephrology; Michael Luethy, a veterinary cardiologist in Northbrook, Ill.; and Ron Lyman of Fort Pierce, Fla., a veterinary internal medicine specialist with a formal residency in neurology.

Can you amaze me with a cutting-edge procedure?
Francey: Kidney transplants have been done in cats for several years, and very recently in dogs. This is done mostly at universities. Here, we have donor animals used in the lab. It's an exchange: An animal gives up the kidney and gets a new home. The person whose pet is getting the kidney must adopt the donor.

In cats, the kidney is about a tenth of the size it is in people, but the real problem is the blood vessels. They're so small, we do the surgery under a microscope. In dogs, the issue is rejection of the new organ. They don't do quite as well with the rejection drugs as cats, but we're learning. Kidney failure often is a disease of older cats. The transplant isn't a cure, but 75% of the cats survive fine for a least a year, and about half make it to five years.

Luethy: We're doing open-heart surgery in dogs. When an animal is seen by a cardiac veterinarian, the technology is pretty much identical to that in human medicine. We also implant pacemakers in dogs. The pacemaker companies offer [nearly expired] pacemakers to veterinarians. In most cases, the [pacemaker] battery outlives the dog. Our success rate is quite good with these surgeries.

You did amaze me! And the cost of such procedures must amaze -- even overwhelm -- some clients.
Francey: A kidney transplant is about $6,000 to $11,000. That's not inexpensive. And since the economy has been suffering, we aren't getting as many appointments. Still, over the past three years, 87 cats and 13 dogs came here for the surgery. Of course, the same surgery would be many times more in people.

Luethy: In dogs, open-heart surgery is about $6,000 to $12,000. In people, we may be talking $200,000 total.

Lyman: It's ordinary pet owners -- and I don't mean rich people -- who have demanded this growth in specialty medicine. They want the best for all their family members.

Luethy: I grew up in rural Wisconsin. Instead of heart surgery, the "cure" would have been a bullet. It's cheaper. But you wouldn't do that to a family member today. Last Christmas, a family of limited means had to make a decision. Mom said to the kids, "If we spend the $1,000 necessary [to help the dog], you'll have to give up your Christmas presents." Those kids didn't hesitate for a second.

Lyman: What matters most are quality-of-life issues. When I'm pretty sure brain surgery will eliminate seizures [for example], most people say, "Absolutely."

Bergman: That's where we are with cancer treatments. It's all about quality of life. We don't ever recommend treatment if we see the quality of life diminishing. When the pet is no longer enjoying life, we begin thinking about palliative treatments [making the pet comfortable for the time he or she has left]. But cancer has a stigma it shouldn't. The truth is that in pets, unlike people, chemotherapy doesn't make them feel sick. In all cancers combined, we estimate about half of them are cured.

Are you ever frustrated by what you can't do?
Luethy: Feline hypertrophic cardiomyopathy is an inherited abnormal thickening of the heart. Sometimes cats suddenly die of this [similar to athletes suddenly dropping while practicing or competing]. Because of the recent availability of ultrasound equipment in veterinary medicine, it's being diagnosed far more often. Still, there's no cure; it's almost always fatal. That's very frustrating.

Do you work and share research with non-veterinary physicians?
Bergman: All the time. Right now, we're participating in vaccine studies with the Memorial Sloan-Kettering Cancer Center [in New York]. When cancers occur, our immune system does not see them as foreign. To wake up the immune system, we're trying a vaccine made of DNA that comes from a different species. [That] DNA wakes up the immune system, which is why we gave human DNA as a vaccine to dogs. This indeed woke up their immune systems to fight melanoma. Imagine -- human DNA in dogs. It's very Star Trek. But it's working. Now, we're trying mouse DNA in people, and it's all been because of the work we first did with dogs.

Lyman: SARS is caused by a mutation of a coronavirus [which causes the common cold]. There's a fatal disease in cats called feline infectious peritonitis; this is a mutation of the feline coronavirus, which is otherwise benign. Perhaps, if research is done to determine what causes that mutation in cats, it may help to determine why the coronavirus sometimes mutates to cause SARS. If an effort is made, veterinary medicine can be astonishing, but research is expensive.

Luethy: In only a few years, we've been part of an explosion of expertise and quality of pet care. This is one reason pets are living longer than ever.

Contributing Editor Steve Dale is the magazine's pet expert.