By Jimmy Magahern

Dr. Stacey Hoffman can check the pulse of the economy by tallying how many old cats she gets to save each month.

 “I can think of a client I saw several years ago who had a cat with a serious medical problem, and back then, money was no object to her,” says the veterinary specialist, who splits her time working at animal clinics in Scottsdale and Avondale. “She was in real estate, and she could basically hand you a blank check for any amount.

“When I saw her last year — different cat, different problem — that was no longer the case, of course,” Hoffman says. “And she told me point blank that her situation had changed, and she just couldn’t afford another costly operation.”

In an economy still gone to the dogs, Hoffman’s tale of two kitties illustrates a sad but inescapable fact: No matter how much some of us may value our pets, at some point nearly everybody reaches a limit on how much they are willing, or able, to spend on vet bills.

“For some the cut-off is a hundred dollars; for others it can be $10,000,” Hoffman says. “But even for people who’ll do anything for their pet, there’s still not an infinite supply of money. If the cat who had the $10,000 kidney transplant now develops cancer, they may not be able to pursue treatment for that.”

Pity the kitty with the tapped-out owner — especially given that today’s veterinary specialists are more skilled than ever at fighting virtually any animal ailment, from cataracts and crooked teeth to cancer or a cracked hip.

“Our veterinary colleges have done a pretty amazing job of training board-certified residents to go out and establish their own specialty practices,” says Dr. Bill Horne, director of the esteemed animal hospital at New York’s Cornell University, where now-common operations like canine hip replacements were pioneered. “Things that were once done exclusively at veterinary colleges and teaching hospitals are now being done by veterinary specialists all across the country. There are surgical neurologists now who can do brain surgery on dogs and cats.”

Problem is, those advanced operations don’t come any cheaper for Rover than they do for Grandpa. “The implants that you use in a total hip replacement on a dog aren’t any less expensive just because they’re developed for dogs,” Hoffman explains. And few employers, especially in these recessionary times, are offering anything as lavish as pet insurance. Even Phoenix-based Petsmart, whose headquarters hosts regular bring-your-pet-to-work Fridays and where workers are encouraged to keep tropical fish and snakes at their desks, does not currently offer pet insurance policies to its employees, according to media spokesperson Kelley Moore.

“You do see those Progressive Insurance ads now with ‘Flo’ talking about insuring your dog — I think it shows a Golden Retriever,” says Horne. “So there’s some evolution going on. But pet insurance is still not very common.” Indeed, out of the over 71 million U.S. households which keep some kind of pet, less than seven percent of those animals are currently insured, according to the American Pet Products Manufacturers Association — although that figure is up from four percent just two years ago.

The ability of vet specialists to cure just about any animal ill today — for a price — has only amped up the guilt for pet lovers at the end of their financial leash. A decade ago, a dog diagnosed with cancer was often considered a goner. Not today — as long as the dog’s owner can foot the bill for canine chemo.

“Things like kidney transplants can be done on cats today — but only for people who have between $5,000 and $10,000 to pursue it,” says the M.I.T. and Harvard-educated Hoffman, who specializes in internal medicine. “You hate to say that it comes down to money, but more and more today, it does. And that brings up the ultimate distinction between human medicine and veterinary medicine: We have the option of humane euthanasia for patients with problems that the client cannot afford to fix.”

Not that it makes it any easier for vets to tell pet owners they could save Tabby, if only Tabby’s owner was a little more well-heeled.

“Imagine if a physician had to tell a client, ‘If we can’t do the procedure because you can’t afford it, we’re going to have to euthanize your child,’” Hoffman says, contrasting the vet’s plight with the options medical doctors have available to fund care of indigent patients. “That’s not something that they have to deal with. But veterinarians have to deal with those issues every day.”

More Than Spay and Shots

Dr. Ross Lirtzman sits down with his 1:30 p.m. patient — a big, good-natured bulldog named Stanley — and immediately Stanley is all over Lirtzman, licking him in the face like a favorite family member. With Lirtzman’s own bulldoggish build and white goatee, the two make a natural wrestling duo.

“Dog loves his doctor!” says Stanley’s owner, Ed Codey, with a shrug. And for good reason: thanks to Lirtzman’s expertise in a still relatively new form of canine knee surgery known as Tibial Plateau Leveling Osteotomy, or TPLO, the 5-year-old bulldog is able to walk today.

“I just feel very lucky that I found Dr. Lirtzman,” says Codey, whose regular veterinarian referred him to the board certified orthopedic surgeon when Stanley’s corkscrew tail had become badly infected and needed to be removed. While back there, Lirtzman, who devotes most of his practice to performing animal knee and hip surgery and tending to broken bones and dislocated joints, looked at Stan’s stiff knee and diagnosed the problem as a pulled anterior cruciate ligament, and was able to obtain a state-of-the-art prosthetic joint from a manufacturer months before its commercial introduction.

The operation earned Stanley dog park props as the first Arizona dog with the bionic bender, and then the second four months later when Stanley needed the identical operation done on his other knee.

Although the TPLO surgeries, which typically range between $2,000 to $4,000, cost Codey a bundle — “I asked the doc if I could work off the bill cleaning his house!” he jokes — the devoted pet owner contends he ultimately fared better starting with the right specialist than he would have bouncing around from one general practice vet to another.

“If I had gone to somebody else, they probably would have recommended one procedure, then another, and I would have eventually ended up here anyway,” says Codey, who admits to being the kind of dog owner who would “live out of a cardboard box” before skimping on his pet’s health. “I was lucky that I started off with the right guy.”

Lirtzman, who works out of a showcase facility in North Scottsdale featuring such hospital-grade touches as tiled operating room walls and sanitary, drain-free seamless flooring, believes specialty care can be affordable, if people tackle their pet’s problem with a little of their own research first, rather than rushing off to their usual spay-and-shots vet.

When one is making frequent visits to the vet and getting no good diagnosis for their pet’s problem, and the pet is having to undergo repeated tests and prolonged treatments — all that adds up to more cost, in the long run, for the owner,” Lirtzman insists. “Getting an appropriate diagnosis, sound treatment recommendations and having the right work done first means things will go better, faster — and that can actually mean less cost to the owner in the end.”

Specialists are relatively easy to find. The Arizona Veterinary Medical Association maintains a searchable list on its website (azvma.org), which includes 68 board certified specialists in the Valley alone. “Here in Phoenix, there are animal eye doctors, dentists, cardiologists, dermatologists, neurologists, internal medicine specialists, oncologists or cancer specialists, surgeons, even behaviorists,” says Lirtzman. “And people can find their contact information right there on the AZVMA site. But not everybody knows to go there.”

Instead, most specialists depend on referrals from general practice vets, who will sometimes attempt a procedure themselves rather than send the client to someone more qualified.

“Unfortunately, not every veterinarian is like Ed’s, where they’re willing to send you to the right specialist for a particular problem,” Lirtzman says. “And that’s where things get a little sticky. There are some veterinarians who went to a weekend seminar or took a short course and will say they’re qualified to do surgery. And unlike in human medicine, there’s not a hospital review board to grant or deny them privileges.

“We hope that veterinarians are referring based on what’s best for the animal, but that’s not always the case,” says Lirtzman, who remains more than a little critical of the average animal GP. “As specialists, we want to let people know we’re out there, and they can come to us first. They don’t need a referral.”

Dogs Don’t Know It’s Not Chemo

Dr. Betsy Hershey has been treating dogs and cats for cancer for the past 13 years and says she’s seen an increase in the population of pet owners willing to “go that extra mile” for their pets.

“More and more, pet owners consider their pets as members of the family,” Hershey says, “and they are requesting the same kinds of procedures and treatments for their pets as they would for any other member of their family.”

In some ways, our back-to-basics economy has benefited the four-legged family member. Why ante up for the 60-inch plasma when there’s a playful pooch for entertainment? With our reordered priorities, even the urban chicken is considered the better bling.

Still, Hershey, one of about 10 board-certified veterinary oncologists in the Valley, admits that the best veterinary treatments available today are often frustratingly out of reach for many pet owners.

“In this city, we’re fortunate enough to have radiation therapy for animals, we have access to MRI, V/Q scan, digital radiography. But not everybody is able to afford those kinds of treatments for their pets,” says Hershey. As an example, she mentions lymphoma treatment as one of her own specialties, with the most aggressive protocol calling for six months of weekly to bi-weekly chemotherapy sessions. “That certainly gives the best response rates and the lengthiest remission times. But depending on the size of your dog, it can also cost between $4,000 and $6,000.”

As a less-expensive alternative, Hershey also offers her patients holistic therapies like veterinary acupuncture and a form of Chinese massage called Tui-na. “A lot of the Chinese medicine we do is aimed at supporting the immune system, improving quality of life and trying to extend survival time for the animal,” Hershey says.

Nationwide, alternative veterinary medicine has become a booming field, in some cases leading to advances on the human side. Because FDA approval is easier to obtain for treatments used in animals than it is for use in humans (indeed, dogs are often test species for some compounds), things still in the trial phase for humans, like embryonic stem cell treatments, are already yielding successful results in the animal world.

For the pets themselves — who, Hershey says, can actually tolerate aggressive therapies like chemotherapy better than humans — the homeopathic remedies are kind of like the Beggin’ Strips of veterinary medicine. Dogs don’t know it’s not chemo, and in the end, they may live just as many quality dog years with the mugwort herbs and acupuncture needles.

“If the goal is really, ‘I want my dog to feel good, to feel better and to buy some more quality time that I can spend with him,’ we can achieve that goal a lot of times through alternative medicine,” Hershey says.

“We don’t cure a lot of cancer in veterinary medicine, unfortunately,” she adds. “Mostly, we’re looking at buying time.”