By SHELLY GARCIA
Dr. Rodney D. Ayl spends about an hour on initial consultations with cancer patients and their loved ones.
He discusses treatment options, costs and sometimes even euthanasia, not a topic that comes up in most cancer cases. But then again, Ayl's patients are dogs and cats.
Ayl, who believes he's the only veterinary oncologist providing radiation treatments in L.A., is one of 11 specialists who practice at Glendale-based Animal Specialty Group Inc. He and his colleagues surgeons, neurologists, opthalmologists and internists are part of a small but growing group of veterinarians who are bringing the same sophisticated medical treatments used on humans to their four-legged friends.
Practices such as 3-year-old Animal Specialty Group have grown from makeshift operations working out of emergency clinics a few days a week to full-fledged hospitals with a staff of specialists who tackle everything from heart disease to hip replacements.
"People who own animals have been exposed to the fact that there are a lot of technological innovations available," said Dr. Gail Golab, assistant director of education and research at the American Veterinary Medical Association. "They're interested in getting the same quality of care for their animals as they would for themselves."
But however deserving, Fido and Fluffy are not humans, a central fact that colors how specialists like Ayl deliver medicine and how they shape their businesses with respect to staffing, services and fees.
While the cost of many procedures are often comparable to running a human hospital, veterinary specialists find they have to shave prices to a level the market can bear.
"Our profit margin is much lower than a general practice," said Kirk L. Wendelburg, a veterinary surgeon and founder of Animal Specialty Group. "When you're giving a vaccine that costs $1 and you charge $20, it's a pretty good margin. When you're putting in a hip, and it costs $1,000, you can't mark it up, because it goes out of the reach of some people. We use the exact same chemotherapy that's used in people, and some of these things cost well over $1,000, and we can't mark it up very much. So the profit margin is not very good."
Still, revenue at the Animal Specialty Group grew to $2.6 million in 1998, up from $1.7 million in 1997. And Ayl says his practice has grown considerably. Last year he performed about 1,000 radiation treatments, as many as he performed in the first three years of his oncology practice combined.
But the costs connected to the procedures can be prohibitive for many clients. If an animal's tumor is localized, a full course of palliative radiation treatment geared to eliminating pain can run under $1,000. But animals with other cancers may require 12-16 radiation treatments at a cost of $250 to $300 per treatment. And chemotherapy can range from $150 to $1,000 per treatment, which may need to be repeated periodically over the course of several years.
Specialists are keenly aware that their most important job is often to help a client through a difficult decision-making process that can include a consultation with a psychologist and may ultimately lead to a decision to euthanize the pet.
"Once you have the diagnosis of cancer, it's probably a chronic, incurable disease," Ayl said. "There is no right or wrong answer."
Ask most of these specialists and they'll tell you a personal story about the dog or cat that influenced them to endure as much as four years of training over and above what's required of veterinarians in general practice. But once in practice, the demanding reality can overcome those good intentions.
With only about 5 percent of animal patients carrying health insurance, the market for these high-cost procedures is limited.
"In this practice, our biggest problem is remembering that it is a source of income," said Alexander Werner, a veterinary dermatologist who treats such problems as infections, chronic allergies and auto-immune diseases from his practice, Valley Veterinary Specialty Services in Studio City. "One of our biggest problems is not charging sufficiently or discounting the service. It tends to be that we get into the emotions of it as well (as the business of delivering care.)."
Werner said he has been able to negotiate lower prices for some equipment because suppliers, aware of the constraints of a veterinary practice, sometimes offer discounts. One particular type of laser was discounted because it doesn't include an attachment for treating wrinkles, standard in human hospital models. "Sharpei owners usually don't want to remove their dog's wrinkles," Werner joked.
But such options are not available in other specialties. Unable to afford the multimillion-dollar cost of state-of-the-art radiation equipment, most veterinary oncologists don't even offer such therapy. And radiation centers for humans, fearful that their two-legged clients will object to sharing the facility with animals, won't lease space to veterinary oncologists.
After four years spent searching for a San Fernando Valley facility willing to lease to him, Ayl has just reached a deal to share a human facility in Sherman Oaks.
Until now, he and his patients have had to go to Long Beach for treatment, a logistical nightmare that required patients and clients to gather on scheduled days and travel to the facility together, waiting while all the treatments were performed.
Unlike human cancer treatments, radiation and chemotherapy are delivered to pets in smaller doses, geared less to curing the animal or increasing longevity than to eliminating pain and prolonging a good quality of life for as long as possible. As a result, side effects are minimal.
"It's important to not let the treatment be worse than the disease," Ayl said. "The aim is to do as much as we can to the cancer without affecting the pet."
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