Operation Save Duke

Why we traveled 1,665 miles (one way) to save our dog, and why you may one day do the same for yourself, someone in your family, or your Employees.

Two years this week, I was laying in bed and couldn’t sleep. Our three year old English Bull Dog Duke was sitting up in bed, and I could hear him whistling as he was breathing. I woke my wife, and we agreed we needed to get him to the veterinarian.

After a quick exam, it determined that he had fluid in his thoracic cavity. His chest was tapped and they drained nearly 2 liters of fluid. Once tested, it turned out to be an idiopathic pleural effusion.

What the hell is an idiopathic pleural effusion? Imagine your body dumping fatty lymphatic fluid into your chest. Over time as the fluid builds it restricts the space around the lungs, so instead of filling to their full capacity, they only expand like a quick puff into a balloon. If the flow is low enough, the body will reabsorb it, but if not, it’s like drowning. The prognosis: not good.

2nd, 3rd, and 4th opinions.

We immediately begin to research, and seek out additional opinions. What we found was that it was rare, survival rates were low, and that the veterinary community was often puzzled by not only the cause, but also the fix. 

Our first second opinion was with a veterinarian that was recommended by our local vet. They are a house of veterinary specialists, who had seen conditions like this in the past, and recommended a surgical solution. 

The 3rd opinion had seen this as well, and recommended changing to a white diet, supplementing with amino acids and rutin, as well as continuing with taps. 

The 4th opinion performed an echo, and recommended surgery. They mentioned that they do two or three of these a year, locally, at a cost of about $8,000.

Throughout this time, the immediate remedy was to continue with chest taps. The problem is that over time, the tissue would scar over, and you wouldn’t be able to extract the fluid, so we couldn’t do this too frequently, and almost push him to his limits.

No, we didn’t have pet insurance. We found ourselves really confused, lost, and distraught that an otherwise perfectly healthy, and happy dog, may end his days seeing only palliative care before slowly drowning inside his own body. 

The surgical option was pretty heavy duty. The most common approach was to crack the chest open, perform a sub-total pericardiectomy, locate the leaky plumbing, clamp them, and see if I works.

I’ll stop here and note that this where many people would have called it quits – and I’d be lying if I said we didn’t consider it.  There were zero promises the surgery would work, and if it did, we weren’t sure how long he would last. The last thing we wanted to do was put him through hell to have it all not work out in the end.

I will note that this is the same dog that did not leave my side when I was recovering from my knee injury - a full 2 months on the couch, not to mention following surgeries. He never left my wife's side when she had a migraine, or didn't feel well. There was no way we could turn our back on him.

Dr. Do-Google.

I continued to hit the web, sometimes hours on end into the night, reading through forums of others who had similar challenges with their four-legged friends, scholarly journals, and more. I kept seeing only dismal outlooks, reoccurrences, <50% success rates, and more. 

I researched to find the best Veterinary Schools in the country, and narrowed to Cornell, NC State, Coloardo State, and Stanford.

-         Cornell University had gate keepers, and wouldn’t entertain any interaction with the faculty, but told us to bring him and they would take-a-look. Ugh – sounds like people medicine.

-         NC State was about the same, but the price quoted was much higher, and carried no promises.

-         Stanford and Colorado State were initially both ruled out due to distance. He couldn’t fly so we didn’t see this as a good option.

I kept digging for research, scholarly articles, and more, before coming across an abstract form the AVMA. The article touted a treatment with an 80% 5 year survival rate. You can see the article here:  https://avmajournals.avma.org/doi/abs/10.2460/javma.239.1.107. I immediately reached out to the Doctor via email and…..….. he actually responded! 

He took the time to address my questions, outline his methodology which achieved the 80% success rate, and recommend next steps. He immediately brought more experiences than anyone we had spoken with at that time, treating at least 10 cases in the last 24 months.

Over the next two weeks I spoke with his assistant to gain more information, set-up the necessary tests locally, but also get an understanding of cost, before booking the trip to Colorado.

The estimated cost at CSU was $5,400. This is just a little over half the price of doing so locally. The game plan was simple:

-         We would both drive out together over Labor Day weekend

-         I’d stay the night, before flying back

-         My wife would stay there for about a week while he recovered

-         I’d fly back out, and we would all drive back home.

All-in, the cost would have been about the same or less than doing the same procedure locally, with a provider that had only performed several such procedures in the last 24 months, no research backing it, etc.

Outcomes

The initial surgery went well, however did not fully resolve the issue. There was still additional fluid that was leaking, albeit slowly. The team at CSU recommended another surgery, but less invasive this time, while also installing a pleural port to extract fluid. This surgery seemed to work, however Duke also developed an infection. After hanging out in the “puppy ICU,” losing nearly half his body weight in that week, receiving several blood transfusions, he was released once the infection cleared, and with no signs of leakage. 

The photos span the 3 weeks, from the day he arrived in Ft. Collins CO, to after his first surgery, and before he turned the corner.

Two years later, he is still going, with no leaky plumbing, no subsequent taps, and otherwise a clean bill of health.

Would we do it again? Absolutely. Duke has had two more great years of life with no restrictions, and shows no sign of slowing down anytime soon.

Takeaways

This is the fun part. Never in my mind did I ever expect a situation where we would pack our bags and drive across the country for a vet appointment. But we did! Here is why you may do the same:

Outcomes: Health care for you especially, and maybe even your pets, should be focused on outcomes. Anyone can provide a price for a surgery, but can they provide efficacy in their outcomes? After seeing some of the best veterinary providers in a 45 mile radius of Washington DC, we were just simply not happy with what we were hearing. 

In human medicine we too often blindly trust our doctors with the advice they give. That’s why things like being board certified, fellowships, and more are important. We did our research and grew our healthcare purchasing radius, the same way we do with health plans. If we could seek the service of a leading (world-renowned) veterinary professional, at a lower cost, why WOULDN’T we consider that opinion. 

Is your doctor the best at what they do? Probably not, but how would you know otherwise? They very well may get the job done for you, but it’s worth a deeper dive. If dire enough of a situation, you may want to confirm that they are board certified, have performed fellowships, and also not have sanctions against them by the state, or pending/past medical malpractice cases. FYI – this describes only about 25% of doctors in the US.

Cost: The one really nice thing about veterinary medicine is that costs are transparent. Try that with people medicine. While their costs may not be published, you are generally able to secure up-front pricing for anything from lab panels, to drugs (yes, even sometimes the same ones used as humans but dispensed at the veterinary office), and more.

One of the things that we find with people medicine is that some of the best performing doctors are already some of the lowest cost. Practice makes perfect, and in doing so practice can also make someone cost-efficient. It is not always about who is the lowest cost, but someone who may be an efficient-cost. 

When it comes to cost in people medicine, there is still much to be desired in terms of price transparency, so until we reach nirvana in this regard, we will continue to deploy solutions that triangulate a fair price for a service which is based on costs, and not discounts.

Application

Today, the same solutions for people medicine are in play as well. The nice thing however is that the process can be on autopilot. This is mostly in the realm of self-funded health plans, with a surgical (no pun intended) approach to provide solutions to members to seek high quality care, with better outcomes, at a lower cost.

When it comes to cost in people medicine, there is still much to be desired in terms of price transparency, so until we reach nirvana in this regard, we will continue to deploy solutions that triangulate a fair price for a service which is based on costs, and not discounts.

The “why’s” are mostly the same as with my example. The “how,” is through your health plan. Fully insured health plan solutions leave members to the carrier’s devices. Health insurer networks have little desire to upset their network of providers by funneling patients to another, better doctor. Insurers pride themselves on their fictitious discounts, and offer you a “great deal” when it comes to renewal time, only giving a “trend” increase of 10%. 

In a self-funded plan we seek to provide a robust solution for healthcare provider choices. Note: I did not say “network.” While still not commonplace, removing a network altogether can help to bring you closer to a more rational acquisition strategy, leaving you able to better manage your supply chain. In either scenario, we can bundle solutions for pre-selected leaders that fit the bill for being cost-efficient and also providing better outcomes. Members may choose to seek out care from these high quality providers – many times at no cost as a solution to offer incentive. 

With more and more Americans struggling with their own healthcare bills, measly outcomes, and other challenges, don’t you think it’s time that you consider similar options? You may choose to:

-         Providing tools to navigate the healthcare landscape – instead of doing the same type of research I conducted on my own

-         Expanding your purchasing radius for health care services – even internationally

-         Drilling down to the actual cost for services – even direct contracting with providers

-         Building easy pathways to seek better care options – even triggers for second opinions

-         Incentives to pursue the best options for care – even $0 treatment options

-         And more.

Aside from saving money, all of these can help to literally be a life saver.

The bottom line: we often pay too much for healthcare, with poor outcomes. Simply expanding your reach can be an extremely wise thing to do – even if its just an option for Employees. You do not need a PPO to do this, but rather you need a better acquisition strategy.