Patient Money: Containing the Costs of Pet Care

Last year the Nocella family adopted two puppies, a pit bull mix named Pokie and a “puggle” named Browny. Since then, Ms. Nocella estimates, the family has spent as much as $5,000 on veterinarian bills.

The dogs have had routine checkups and shots, of course. But then there were unexpected costs: Pokie arrived with a bad case of worms and kennel cough; some strange bumps on her paws turned out, after $700 worth of tests, to be warts. Browny has severe allergies and requires frequent trips to the vet.

Last November, Pokie swallowed Advil pills, which are toxic to dogs. She went into renal failure and required emergency treatment overnight in a nearby animal hospital. The treatment was successful and Pokie is fine, but the incident set the Nocellas back $2,300.

Pet owners like Ms. Nocella are spending more on veterinarian bills than ever before. The American Pet Products Association estimates that Americans will spend $12.2 billion on veterinary care this year, up from $11 billion last year and $8.2 billion in 2006.

Advances in veterinary medicine mean more extensive, and expensive, treatments are available for animals, but even ordinary costs like flea and tick protection can add up quickly. Here are some ways to curb those costs while still giving your pet the best of care.

LOW-COST ALTERNATIVES Local shelters often offer free or low-cost spaying and neutering for dogs and cats, said Dr. Louise Murray, vice president at the American Society for the Prevention of Cruelty to Animal’s Bergh Memorial Animal Hospital in New York and author of “Vet Confidential.” To find a shelter near you, check the A.S.P.C.A. Web site at www.aspca.org/pet-care/spayneuter.

Shelters where pets can be adopted may offer low-cost vaccinations and checkups. Mobile clinics, usually sponsored by local governments or animal protection agencies, also provide routine pet care for far less than a traditional vet would charge.

Veterinarian schools are another good source of low-cost care. Students are carefully supervised by qualified veterinarians, so pets receive quality care — everything from heartworm tests to major surgery, often for as little as a third of the price at a veterinarian’s office.

THE RIGHT VACCINES Keeping up with a pet’s shots will save money, not to mention misery, in the long run by preventing many serious illnesses. But that does not mean a pet needs every vaccine available.

“A corgi who lives on the Upper East Side doesn’t need the same protocol as a Labrador in Connecticut,” Dr. Murray said. “Your veterinarian should customize a vaccine plan that fits your pet.”

A HEALTHY DIET Many vets sell prescriptions and high-quality pet food, but the same brands are sold for much less at many pet supply stores or Web sites. Still, do not skimp on quality.

“Cats, for example, are carnivores and aren’t meant to eat carbohydrates,” Dr. Murray said. “Feeding them only the cheap dried food can lead to diabetes or blockages that will cost you a lot more in the long run than the price you’ll pay for the right food.”

DRUG DISCOUNTS If a pet needs regular medication, discount chains such as Costco can be cheaper than a regular drug store or the vet’s office, said Dr. Sharon Friedman, a veterinarian at the Berkley Animal Clinic in Berkley, Mich. But consult a veterinarian first, she advised, to be sure to buy the right medicine at the right dosage.

On the other hand, do not assume that tick and flea treatments or heartworm medications are cheaper at the big discount chains. Manufacturers want to distribute these medicines through veterinarians’ offices, so they often offer promotions and discounts there that are not available elsewhere.

“One company recently offered two free tick and flea treatments if you bought six doses. That worked out to be less expensive than PetMeds, a popular online store, or Costco,” Dr. Friedman said. “It often pays to ask.”

Many Web sites sell high-quality pet medications at good prices, but a recent Food and Drug. Administration. investigation caught some sites selling counterfeit, unapproved or expired drugs. Beware of any site that sells medications without requiring a veterinarian’s prescription.

The F.D.A. also recommends that consumers look for sites accredited as a Veterinary-Verified Internet Pharmacy Practice Site, part of a voluntary accreditation program.

CONSIDER INSURANCE Pet health insurance is a booming industry, growing more than 20 percent every year, although only an estimated 3 percent of pet owners have bought policies. While Ms. Nocella has never seriously considered buying pet insurance, she does acknowledge it might have come in handy the day Pokie ate the Advil.

But like health insurance for humans, pet insurance can be complicated and highly restricted. Some policies will not cover older pets or genetic conditions that certain breeds are known to have, such as hip dysplasia in retrievers.

Others limit coverage to only one treatment per illness. So if your dog develops asthma, for instance, some policies will cover just the first trip to the vet although treatment will require multiple visits.

Prices for pet insurance can range from $12 to $50 a month, depending on the type and age of the pet and any pre-existing conditions. In almost all cases the pet owner pays up front, then files a claim for reimbursement.

Costs are higher to insure older, sicker pets, or for policies that cover preventive care, such as vaccines and veterinarian office visits.

Many pet owners prefer to save for unexpected vet expenses in an emergency fund instead of paying premiums for coverage they may not use. Dr. Murray suggested putting away a little each week until savings reach $2,000 to $3,000.

“That’s the minimum you’ll need if a serious situation arises and your pet needs lifesaving care,” she said.

 

Patient Money: Containing the Costs of Pet Care

Last year the Nocella family adopted two puppies, a pit bull mix named Pokie and a “puggle” named Browny. Since then, Ms. Nocella estimates, the family has spent as much as $5,000 on veterinarian bills.

The dogs have had routine checkups and shots, of course. But then there were unexpected costs: Pokie arrived with a bad case of worms and kennel cough; some strange bumps on her paws turned out, after $700 worth of tests, to be warts. Browny has severe allergies and requires frequent trips to the vet.

Last November, Pokie swallowed Advil pills, which are toxic to dogs. She went into renal failure and required emergency treatment overnight in a nearby animal hospital. The treatment was successful and Pokie is fine, but the incident set the Nocellas back $2,300.

Pet owners like Ms. Nocella are spending more on veterinarian bills than ever before. The American Pet Products Association estimates that Americans will spend $12.2 billion on veterinary care this year, up from $11 billion last year and $8.2 billion in 2006.

Advances in veterinary medicine mean more extensive, and expensive, treatments are available for animals, but even ordinary costs like flea and tick protection can add up quickly. Here are some ways to curb those costs while still giving your pet the best of care.

LOW-COST ALTERNATIVES Local shelters often offer free or low-cost spaying and neutering for dogs and cats, said Dr. Louise Murray, vice president at the American Society for the Prevention of Cruelty to Animal’s Bergh Memorial Animal Hospital in New York and author of “Vet Confidential.” To find a shelter near you, check the A.S.P.C.A. Web site at www.aspca.org/pet-care/spayneuter.

Shelters where pets can be adopted may offer low-cost vaccinations and checkups. Mobile clinics, usually sponsored by local governments or animal protection agencies, also provide routine pet care for far less than a traditional vet would charge.

Veterinarian schools are another good source of low-cost care. Students are carefully supervised by qualified veterinarians, so pets receive quality care — everything from heartworm tests to major surgery, often for as little as a third of the price at a veterinarian’s office.

THE RIGHT VACCINES Keeping up with a pet’s shots will save money, not to mention misery, in the long run by preventing many serious illnesses. But that does not mean a pet needs every vaccine available.

“A corgi who lives on the Upper East Side doesn’t need the same protocol as a Labrador in Connecticut,” Dr. Murray said. “Your veterinarian should customize a vaccine plan that fits your pet.”

A HEALTHY DIET Many vets sell prescriptions and high-quality pet food, but the same brands are sold for much less at many pet supply stores or Web sites. Still, do not skimp on quality.

“Cats, for example, are carnivores and aren’t meant to eat carbohydrates,” Dr. Murray said. “Feeding them only the cheap dried food can lead to diabetes or blockages that will cost you a lot more in the long run than the price you’ll pay for the right food.”

DRUG DISCOUNTS If a pet needs regular medication, discount chains such as Costco can be cheaper than a regular drug store or the vet’s office, said Dr. Sharon Friedman, a veterinarian at the Berkley Animal Clinic in Berkley, Mich. But consult a veterinarian first, she advised, to be sure to buy the right medicine at the right dosage.

On the other hand, do not assume that tick and flea treatments or heartworm medications are cheaper at the big discount chains. Manufacturers want to distribute these medicines through veterinarians’ offices, so they often offer promotions and discounts there that are not available elsewhere.

“One company recently offered two free tick and flea treatments if you bought six doses. That worked out to be less expensive than PetMeds, a popular online store, or Costco,” Dr. Friedman said. “It often pays to ask.”

Many Web sites sell high-quality pet medications at good prices, but a recent Food and Drug. Administration. investigation caught some sites selling counterfeit, unapproved or expired drugs. Beware of any site that sells medications without requiring a veterinarian’s prescription.

The F.D.A. also recommends that consumers look for sites accredited as a Veterinary-Verified Internet Pharmacy Practice Site, part of a voluntary accreditation program.

CONSIDER INSURANCE Pet health insurance is a booming industry, growing more than 20 percent every year, although only an estimated 3 percent of pet owners have bought policies. While Ms. Nocella has never seriously considered buying pet insurance, she does acknowledge it might have come in handy the day Pokie ate the Advil.

But like health insurance for humans, pet insurance can be complicated and highly restricted. Some policies will not cover older pets or genetic conditions that certain breeds are known to have, such as hip dysplasia in retrievers.

Others limit coverage to only one treatment per illness. So if your dog develops asthma, for instance, some policies will cover just the first trip to the vet although treatment will require multiple visits.

Prices for pet insurance can range from $12 to $50 a month, depending on the type and age of the pet and any pre-existing conditions. In almost all cases the pet owner pays up front, then files a claim for reimbursement.

Costs are higher to insure older, sicker pets, or for policies that cover preventive care, such as vaccines and veterinarian office visits.

Many pet owners prefer to save for unexpected vet expenses in an emergency fund instead of paying premiums for coverage they may not use. Dr. Murray suggested putting away a little each week until savings reach $2,000 to $3,000.

“That’s the minimum you’ll need if a serious situation arises and your pet needs lifesaving care,” she said.

 

Patient Money: Containing the Costs of Pet Care

Last year the Nocella family adopted two puppies, a pit bull mix named Pokie and a “puggle” named Browny. Since then, Ms. Nocella estimates, the family has spent as much as $5,000 on veterinarian bills.

The dogs have had routine checkups and shots, of course. But then there were unexpected costs: Pokie arrived with a bad case of worms and kennel cough; some strange bumps on her paws turned out, after $700 worth of tests, to be warts. Browny has severe allergies and requires frequent trips to the vet.

Last November, Pokie swallowed Advil pills, which are toxic to dogs. She went into renal failure and required emergency treatment overnight in a nearby animal hospital. The treatment was successful and Pokie is fine, but the incident set the Nocellas back $2,300.

Pet owners like Ms. Nocella are spending more on veterinarian bills than ever before. The American Pet Products Association estimates that Americans will spend $12.2 billion on veterinary care this year, up from $11 billion last year and $8.2 billion in 2006.

Advances in veterinary medicine mean more extensive, and expensive, treatments are available for animals, but even ordinary costs like flea and tick protection can add up quickly. Here are some ways to curb those costs while still giving your pet the best of care.

LOW-COST ALTERNATIVES Local shelters often offer free or low-cost spaying and neutering for dogs and cats, said Dr. Louise Murray, vice president at the American Society for the Prevention of Cruelty to Animal’s Bergh Memorial Animal Hospital in New York and author of “Vet Confidential.” To find a shelter near you, check the A.S.P.C.A. Web site at www.aspca.org/pet-care/spayneuter.

Shelters where pets can be adopted may offer low-cost vaccinations and checkups. Mobile clinics, usually sponsored by local governments or animal protection agencies, also provide routine pet care for far less than a traditional vet would charge.

Veterinarian schools are another good source of low-cost care. Students are carefully supervised by qualified veterinarians, so pets receive quality care — everything from heartworm tests to major surgery, often for as little as a third of the price at a veterinarian’s office.

THE RIGHT VACCINES Keeping up with a pet’s shots will save money, not to mention misery, in the long run by preventing many serious illnesses. But that does not mean a pet needs every vaccine available.

“A corgi who lives on the Upper East Side doesn’t need the same protocol as a Labrador in Connecticut,” Dr. Murray said. “Your veterinarian should customize a vaccine plan that fits your pet.”

A HEALTHY DIET Many vets sell prescriptions and high-quality pet food, but the same brands are sold for much less at many pet supply stores or Web sites. Still, do not skimp on quality.

“Cats, for example, are carnivores and aren’t meant to eat carbohydrates,” Dr. Murray said. “Feeding them only the cheap dried food can lead to diabetes or blockages that will cost you a lot more in the long run than the price you’ll pay for the right food.”

DRUG DISCOUNTS If a pet needs regular medication, discount chains such as Costco can be cheaper than a regular drug store or the vet’s office, said Dr. Sharon Friedman, a veterinarian at the Berkley Animal Clinic in Berkley, Mich. But consult a veterinarian first, she advised, to be sure to buy the right medicine at the right dosage.

On the other hand, do not assume that tick and flea treatments or heartworm medications are cheaper at the big discount chains. Manufacturers want to distribute these medicines through veterinarians’ offices, so they often offer promotions and discounts there that are not available elsewhere.

“One company recently offered two free tick and flea treatments if you bought six doses. That worked out to be less expensive than PetMeds, a popular online store, or Costco,” Dr. Friedman said. “It often pays to ask.”

Many Web sites sell high-quality pet medications at good prices, but a recent Food and Drug. Administration. investigation caught some sites selling counterfeit, unapproved or expired drugs. Beware of any site that sells medications without requiring a veterinarian’s prescription.

The F.D.A. also recommends that consumers look for sites accredited as a Veterinary-Verified Internet Pharmacy Practice Site, part of a voluntary accreditation program.

CONSIDER INSURANCE Pet health insurance is a booming industry, growing more than 20 percent every year, although only an estimated 3 percent of pet owners have bought policies. While Ms. Nocella has never seriously considered buying pet insurance, she does acknowledge it might have come in handy the day Pokie ate the Advil.

But like health insurance for humans, pet insurance can be complicated and highly restricted. Some policies will not cover older pets or genetic conditions that certain breeds are known to have, such as hip dysplasia in retrievers.

Others limit coverage to only one treatment per illness. So if your dog develops asthma, for instance, some policies will cover just the first trip to the vet although treatment will require multiple visits.

Prices for pet insurance can range from $12 to $50 a month, depending on the type and age of the pet and any pre-existing conditions. In almost all cases the pet owner pays up front, then files a claim for reimbursement.

Costs are higher to insure older, sicker pets, or for policies that cover preventive care, such as vaccines and veterinarian office visits.

Many pet owners prefer to save for unexpected vet expenses in an emergency fund instead of paying premiums for coverage they may not use. Dr. Murray suggested putting away a little each week until savings reach $2,000 to $3,000.

“That’s the minimum you’ll need if a serious situation arises and your pet needs lifesaving care,” she said.

 

Patient Voices: Obscure, and Often Devastating

 

“It’s like the hidden secret,” said Allison Moore, chief executive of the Hereditary Neuropathy Foundation, who has the disease. “And when you mention, ‘I have C.M.T.,’ people look at you like you have three heads.”

The disease — named for Jean-Martin Charcot, Pierre Marie and Howard Henry Tooth, the researchers who first described it in 1886 — is actually a group of neurodegenerative conditions that gradually degrade the nerves in the feet, legs, arms and hands, usually starting in childhood. There is no medical treatment, though orthopedic braces and corrective surgery can help.

On nytimes.com/health, six patients describe life with C.M.T. Here are three.?

Bernadette Scarduzio, 31

Drexel Hill, Pa.

To have a disease that’s not well known is scary, and you feel like you’re not a part of the world.

I’ve told people that I have multiple sclerosis before, because I know it’s like M.S., and I felt stupid saying I have this disease that no knows of. I felt weird.

I want to be the face for this disease, and I want everyone to know that’s what I have. The people that are hiding, I need them to come out and say, ‘Yes, I have this disease.’ I know the name is silly, and it’s a family disease, and it sucks, but that’s the only way were going to get a cure for C.M.T.

Joseph Torello, 29

Queens

As an actor with C.M.T., the most nerve-racking part of the audition is walking to the center of the room. It’s not the singing; it’s not the dance callback; it’s not the reading; it’s that walk.

Everything is based on looks, and that’s why it’s so nerve-racking and so easy to get into your head when you have something like this. It’s hard enough to get a job, but to have one more hurdle in your way of that job is tough.

Nicholas Zappola, 18

Sag Harbor, N.Y.

At first I was nervous and scared because you’re diagnosed with a disease that you have no idea about, but I knew I wasn’t alone, and I knew that I could talk to my family members that have it.

I walk with a limp. I am in pain constantly, but I don’t let it get to me. You do suffer, but if you strengthen yourself, you can overcome just about anything.

I feel like a stronger-hearted person than most of my friends because I have the capability of going through all this ?— ?keeping a strong mind and helping other people out ?— and it makes me feel good.

 

Patient Money: Using Hypnosis to Gain More Control Over Your Illness

So the news that she needed brain surgery again was hardly welcome. Determined to make her second operation a better — or at least less traumatic — experience, Ms. Ritchie, an insurance marketing representative in Cleveland, turned to an unusual treatment.

At the Cleveland Clinic’s Center for Integrative Medicine, she had four hypnosis sessions in the month before her procedure, during which she addressed her fear of the coming surgery. She also practiced self-hypnosis every day.

Eventually, she said, “I got to a place where I felt a sense of trust instead of fear.”

In February, doctors removed a plum-sized tumor from her brain. But there the similarity to her previous experience ended. Ms. Ritchie woke up from the procedure, she said, feeling “alert and awesome.” She ate a full dinner that night and went home in two days.

“My neurosurgeon was stunned at how little medication I required before and after surgery, and how quickly I bounced back,” she said.

Ms. Ritchie attributes her speedy recovery and calm state to her hypnosis sessions. Used for more than two centuries to treat a host of medical problems, particularly pain management and anxiety, hypnosis is now available to patients at some of the most respected medical institutions in the country, including Stanford Hospital, the Cleveland Clinic, Mount Sinai Medical Center and Beth Israel Medical Center in New York.

Some critics find the research into mind-body therapies unconvincing, but their skepticism has not deterred patients like Ms. Ritchie. And there are researchers who say they believe that by helping patients feel in better control of their symptoms, hypnosis can reduce the need for medication and lower costs.

“It is an effective and inexpensive way to manage medical care,” said Dr. David Spiegel, director of the Center on Stress and Health at Stanford University School of Medicine and a leading authority on hypnosis.

A study by radiologists at Harvard Medical School, published in 2000, found that patients who received hypnosis during surgery required less medication, had fewer complications and shorter procedures than patients who did not have hypnosis. In a follow-up study in 2002, the radiologists concluded that if every patient undergoing catheterization were to receive hypnosis, the cost savings would amount to $338 per patient.

“When patients are groggy from anesthesia drugs, it costs more to recover them,” said Dr. Elvira Lang, an associate professor of radiology at Harvard Medical School and a lead author of both studies. “Hypnosis calms patients.”

If you have a medical condition for which conventional medicine is not working, or you’d like to try a gentle mind-body alternative, hypnosis may be worth considering. Here are some things to keep in mind.

THE THERAPIST There is no uniformly accepted definition of hypnosis, but most experts generally agree that it is an altered mental state in which a patient becomes highly focused and more receptive to social cues.

During a session, the practitioner guides the subject into a relaxed state and then makes specific suggestions to help change a behavior, a perception or a physiological condition. Someone who is trying to quit smoking, for instance, might be told under hypnosis that cigarettes are poisons and that it’s important to care for and respect his body.

Some patients find that hypnosis is a helpful adjunct to traditional psychotherapy.

“Talk therapy engages the conscious mind, which is overwhelmingly facile at creating blocks to avoid hurtful problems,” said Dr. Tanya Edwards, director of the Center for Integrative Medicine at the Cleveland Clinic. “In hypnosis, the therapist is dealing with the subconscious mind and can get at core problems more quickly.”

Whatever the approach, it’s important to find a highly skilled practitioner.

“Hypnosis is like a surgeon’s knife,” said Edward Frischholz, a clinical psychologist in Chicago who has written more than 50 papers on clinical and experimental hypnosis. “In the right hands it can be life-saving, but in the wrong it could cause harm.”

There is no universal licensing process for practitioners who do hypnosis, so look for a licensed health professional — for instance, a psychologist, medical doctor or social worker — who has been trained in hypnosis. Ask your doctors and therapists for recommendations, or go to the Societies of Hypnosis Web site, which allows you to search by ZIP code and specialty.

THE SESSION At your first session, the practitioner will discuss your condition and may administer a short test to assess how hypnotizable you are.

Most people are susceptible to hypnosis. But if someone is clearly not, then the therapist or doctor may try another technique or suggest a different approach to the patient’s problem. Most sessions last about 50 minutes.

Specific conditions — like smoking, a fear of dogs or flying or temporary insomnia — may require just one session. In 2008, the personal health columnist Jane E. Brody recalled in this newspaper that her husband was able to stop smoking after just one session of hypnosis.

“For very circumscribed disorders, hypnosis works very quickly or not at all,” said Dr. Frischholz.

If your problem is more complex, like post-traumatic stress disorder or depression, it may require multiple sessions. “I might spend the first two sessions taking a history and learning about someone’s background,” said Carol Ginandes, an assistant clinical professor of psychology at Harvard Medical School who uses hypnosis in her private practice. “Then I would work with the patient in a very individualized way.”

A session costs between $75 and $200, depending on where you live and the credentials of the practitioner. If the therapist or doctor is in your insurance network, then you may pay only a standard co-payment. Insurers do not cover hypnosis itself, however; it will have to be billed as a part of your counseling, or as an office visit.

THE DO-IT-YOURSELF APPROACH If the thought of someone putting you in a trancelike state makes you uncomfortable, hypnosis with tape or CD at home may be a practical alternative.

CDs made for a general audience, available at Web sites like HypnosisNetwork.com or HealthJourneys.com, may not be able to help you with a particular or complicated condition, like a lifelong struggle with depression, but they may help train you to calm down before a big test or surgical procedure.

Some practitioners may send you home with a custom-made CD or tape that you can use on your own.

Your therapist or doctor may also teach you self-hypnosis, as Ms. Ritchie’s therapist did. You learn how to put yourself in a deeply relaxed, receptive state in which you repeat statements such as “My body is strong and can handle this surgery,” or “I feel calm and relaxed.”

“People think hypnosis is about giving up control,” said Dr. Spiegel. “But it’s actually giving control back to the patients.”