I wrote this in response to a comment on my recent post on small animal dentistry, which has already generated quite the lively discussion! The commenter, Carol S., is the owner of a 5-year-old Yorkie who suffers from diabetes, pancreatitis, cataracts, elevated liver values, and seasonal allergies. His gums and teeth are also in pretty bad shape, and his other health issues have left his owners unable to pay for dental care. Carol challenged us to come up with a solution to get her poor Yorkie on the track to dental health, without breaking the bank. So Carol, here's what I've come up with.

I appreciate the difficult dilemma you are in. Many people experience the same issues with their pets. My biggest ethical issue with my own pets is that as they age, they become even more important to my mental and physical well-being. Because they are aging at a faster rate than I am, health concerns start earlier. For those of us who consider our pets part of the family, it is difficult to conceive that we will likely outlive them. If they are our substitute children, this is emotionally difficult since we live in a society where "children" usually outlive parents.

Although I cannot solve your problem, I can give you a framework in which to address the health care needs of your four-leggeds. The most important consideration is to find a veterinarian who is going to support you with the type of services you are seeking. For example, if your dog is "just a dog" and lives outside you will most likely need only basic health care. Animals belonging in this category are pets, but they aren't viable members of the family structure and are usually considered easily replaceable. If your pet is easily replaceable, you will want to find a clinic that provides minimum care. When a pet like this becomes ill, you can make the decision of whether it would be easier to euthanize and get a new one.

If you are in the category in which your pet is part of the family, you need to search out a veterinary facility that will offer a health care plan specifically made for your individual animal. It is essential that you are a partner in your pet's health care and the hospital staff will spend a lot of time educating you on the recommendations they are giving you.

It is imperative that you find a veterinarian who will serve as your primary care physician. This means they will be in charge of your dog's entire medical record. When it is necessary to send them to a doctor with a higher level of expertise, your primary care veterinarian will facilitate that. A primary care vet can also talk to you about how much your pet's general health care needs will be each year.

It is easy to look at a medical case without seeing the medical records and say I would have done this differently. All of us have 20/20 hindsight. So, while I cannot comment specifically on your dog's condition without medical records, I can give you generalities.

Pancreatitis can be caused by a number of different things. Dental disease predisposes us (whether human or four-legged) to many other diseases and conditions. Pancreatitis is one of the diseases that can occur because of dental disease along with hundreds of others. Diabetes almost always causes cataracts in dogs. This is where your doctor comes in to help you take a hard look at a risk benefit of one medical condition over the other. Cataracts cause the inability to see. Dogs use many more of their senses much more effectively than humans do. Often, people do not realize their dog is blind until a checkup at the doctor reveals it. Cataracts are seldom painful. Dental disease can be excruciatingly painful (if only we would listen to our pets--they are trying to tell us that). I think the story about how pets don't show their pain because of an evolutionary drive to avoid predators is malarkey. I just don't think we as humans are good at observing and understanding the non-spoken language our pets use to communicate.

I would find a way to get the money to address your dog's dental disease. You need to find someone who not only can follow the AAHA dental guidelines, but one who is experienced in excellent anesthesia as your dog is a higher risk patient.

Put both of your dogs on insurance or start a monthly savings account for their health care needs. Although your experience with your dog is highly unusual, it certainly can happen. Major medical insurance can help pay for his various treatments. Visit http://www.healthypet.com/petcare/PetInsurance.aspx for information on how to choose a plan that fits in your budget.

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