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Under cover: The case of the $2,500 neuter and how pet insurance covered it

Posted Sep 07 2008 8:38pm

Maybe you’re not aware of this but some vets are scared of pet insurance. All that paperwork, red tape and the fear of something even more sinister: the specter of managed care that lurks behind every policy.

Me? I’m not so worried that one day how I practice will be altered by my patients’ policies. I’m more worried that my cases won’t get the benefit of the care I can provide. The way I see it, I’d rather risk losing out on the “old ways” of veterinary practice, especially if it means that fewer patients will forgo the therapies available to them.

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Case in point: The number five. That’s how many knee injuries I’ve seen forgo the specialist this month. It’s understandable. $2,500 is just too much money for the average American family to fork over to a surgeon in this withering economy.

Yet after working on one special case over the course of the last week I had cause to consider that number in a more positive light. $2,500 is what it’s going to cost to bring off one dog’s strange neuter scenario (yes, as in castration). And without insurance it wouldn’t have happened. Here’s the unlikely story:

A two year-old Dane comes in with a huge, swollen scrotum (I mean ginormous!). This thing’s in the melon family by the time I behold it.

It had started to swell overnight but his owners decided to wait to see their regular vet (us) instead of surrendering their dog’s care to the unknown emergency hospital. Needless to say, they awoke to wish they hadn’t waited.

Because 150 pounds of Great Dane in the prime of his life is not worth messing around with—especially if he’s painful, scared and deaf, to boot—we sedated him with a micro-dose of medetomidine (Domitor) delivered along with a pain-relieving dose of buprenorphine. Immediately afterward we flicked in our biggest IV catheter and called in a specialist for an ultrasound look-see.

Feverish and still somewhat uncomfortable, but quiet now, this Dane settled in for a gentle ultrasound probing of a scrotum accompanied by several “oh my God’s” on the part of the board-certified internist we use for procedures like this.

“I’m a little out of my depth,” he demurred, explaining that this was NOT his usual case, “but I’ll give it a go.”

Indeed, I don’t know who wouldn’t feel a bit cowed by this monster scrotum. But by this time I was no longer so impressed as the males in the room seemed to be. I mean, the damn thing wasn’t going to explode, much though it appeared to threaten otherwise. I was more anxious to rule out some of the more life-threatening conditions likely to afflict a young, intact male dog’s testes.

My biggest fear was the possibility that one of the testicles had become twisted, a painful emergency condition that leads to a lack of blood supply to the gonad and always necessitates emergency surgery (called "testicular torsion").

Thankfully, the ultrasound confirmed normal testicles in the house. Instead, several huge pockets of fluid dotted the landscape, interspersed with severe swelling of the tissues in between. Poking them with a sterile needle, we discovered rivers of bloody pus in every one. I don’t think I’ve ever been so pleased to diagnose abscesses (likely arising from deep pustules many dogs will harbor on the surface of their scrotums).

Seeing the writing on the wall, the owners had asked me to simply neuter him and get the whole thing over with. Yeah, right. That’s exactly what I need right now—a feverish, unstable patient under the knife at the exact time that his scrotum boasts more blood vessels than a bull elephant’s. No thank you…not unless you really want to risk his life and the success of the procedure.

Instead, I fully anesthetized him to drain each zone in a painstaking procedure that involved placing drains at the site of each of many abscesses. Yes, gross—but immensely rewarding, nonetheless.

My patient was going to be fine. Though his labwork was reflective of a severe infection, appropriate antibiotics (I’d cultured the sites, of course) virtually promised eventual success. In the end, he went home a couple of days later feeling much better, his condition now downgraded from melon to citrus.

A week later, if all goes well, he’ll come in for the neuter he requires to complete the cure. Ultimately, the condition that created the abscesses will persist. Therefore, a special variety of the standard castration procedure called a scrotal ablation is planned. In this surgical approach the whole scrotum is removed along with the testicles, leaving a sizable incision in a dog this large.

It’s not my favorite surgery but it’s one I can handle well. No need to see the boarded surgeon for this one. Ultimately, this dog will go from A to Z without having to leave the hospital for more expensive, specialized care—thanks to my friend the traveling internist and his trusty ultrasound technique.

Nonetheless the bill won’t be a small one. Before all’s said and done this strange case will end up costing the owner about $2,500. Well, actually, it’ll end up costing the owner about $500 once the insurance company’s paid their fair share. And that’s the real point of this post.

Sure, in the end it’s just a neuter (usually valued at just over one-tenth of this price in a dog so large), but it’s a rare neuter indeed that makes for an exciting emergency like this one. I know I’ve never seen a case like this Dane’s (nor have my in-hospital colleagues, despite their eighty years of combined experience). And that’s when insurance works best—for treating the unforeseen conditions our animal patients will occasionally manifest in ways that make routine care seem cheap by comparison.

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When vets balk at the concept of insurance I have many cases like this to point to. After all, where would this patient be without it? He’d either have undergone risky surgery that could have led to sepsis (a whole body infection) and death or he’d have seen the business end of a syringe loaded with pink poison. That’s no choice. Not when we can do so much better.
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